Jeffrey D. Sachs, Professor of Sustainable Development, Professor of Health Policy and Management, and Director of the Earth Institute at Columbia University, is also Director of the UN Sustainable Development Solutions Network. His books include The End of Poverty, Common Wealth, and, most recently… read more

Financing Health and Education for All

NEW YORK – In 2015, around 5.9 million children under the age of five, almost all in developing countries, died from easily preventable or treatable causes. And up to 200 million young children and adolescents do not attend primary or secondary school, owing to poverty, including 110 million through the lower-secondary level, according to a recent estimate. In both cases, massive suffering could be ended with a modest amount of global funding.

Children in poor countries die from causes – such as unsafe childbirth, vaccine-preventable diseases, infections such as malaria for which low-cost treatments exist, and nutritional deficiencies – that have been almost totally eliminated in the rich countries. In a moral world, we would devote our utmost effort to end such deaths.

In fact, the world has made a half-hearted effort. Deaths of young children have fallen to slightly under half the 12.7 million recorded in 1990, thanks to additional global funding for disease control, channeled through new institutions such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

When I first recommended such a fund in 2000, skeptics said that more money would not save lives. Yet the Global Fund proved the doubters wrong: More money prevented millions of deaths from AIDS, TB, and malaria. It was well used.

The reason that child deaths fell to 5.9 million, rather to near zero, is that the world gave only about half the funding necessary. While most countries can cover their health needs with their own budgets, the poorest countries cannot. They need about $50 billion per year of global help to close the financing gap. Current global aid for health runs at about $25 billion per year. While these numbers are only approximate, we need roughly an additional $25 billion per year to help prevent up to six million deaths per year. It’s hard to imagine a better bargain.

Similar calculations help us to estimate the global funding needed to enable all children to complete at least a high-school education. UNESCO recently calculated the global education “financing gap” to cover the incremental costs – of classrooms, teachers, and supplies – of universal completion of secondary school at roughly $39 billion. With current global funding for education at around $10-15 billion per year, the gap is again roughly $25 billion, similar to health care. And, as with health care, such increased global funding could effectively flow through a new Global Fund for Education.

Thus, an extra $50 billion or so per year could help ensure that children everywhere have access to basic health care and schooling. The world’s governments have already adopted these two objectives – universal health care and universal quality education – in the new Sustainable Development Goals.

An extra $50 billion per year is not hard to find. One option targets my own country, the United States, which currently gives only around 0.17% of gross national income for development aid, or roughly one-quarter of the international target of 0.7% of GNI for development assistance.

Sweden, Denmark, Norway, the Netherlands, Luxembourg, and the United Kingdom each give at least 0.7% of GNI; the US can and should do so as well. If it did, that extra 0.53% of GNI would add roughly $90 billion per year of global funding.

The US currently spends around 5% of GDP, or roughly $900 billion per year, on military-related spending (for the Pentagon, the CIA, veterans, and others). It could and should transfer at least $90 billion of that to development aid. Such a shift in focus from war to development would greatly bolster US and global security; the recent US wars in North Africa and the Middle East have cost trillions of dollars and yet have weakened, not strengthened, national security.

A second option would tax the global rich, who often hide their money in tax havens in the Caribbean and elsewhere. Many of these tax havens are UK overseas territories. Most are closely connected with Wall Street and the City of London. The US and British governments have protected the tax havens mainly because the rich people who put their money there also put their money into campaign contributions or into hiring politicians’ family members.

The tax havens should be called upon to impose a small tax on their deposits, which total at least $21 trillion. The rich countries could enforce such a tax by threatening to cut off noncompliant havens’ access to global financial markets. Of course, the havens should also ensure transparency and crack down on tax evasion and corporate secrecy. Even a deposit tax as low as 0.25% per year on $21 trillion of deposits would raise around $50 billion per year.

Both solutions would be feasible and relatively straightforward to implement. They would underpin the new global commitments contained in the SDGs. At the recent Astana Economic Forum, Kazakhstan’s President Nursultan Nazarbayev wisely called for some way to tax offshore deposits to fund global health and education. Other world leaders should rally to his call to action.

Our world is immensely wealthy and could easily finance a healthy start in life for every child on the planet through global funds for health and education. A small shift of funds from wasteful US military spending, or a very small levy on tax havens’ deposits – or similar measures to make the super-rich pay their way – could quickly and dramatically improve poor children’s life chances and make the world vastly fairer, safer, and more productive. There is no excuse for delay.

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Instead of the proposition that seems to position the Fund as a charity, sustainability demands perhaps that the proposition must position the Fund as an Investment opportunity - the Assets of the Fund acquiring a value enhancement feature. In fact, Professor Sachs has articulated similar propositions that create Funds for other planetary objectives like Climate Control and Disease Control (Ebola). Multilateral propositions that positions Funds as charitable opportunities seem unable to take off - by crafting the Funds as Investment opportunities, whose NAV has growth dimensions, the attractiveness can become unassailable. Read more

To Christopher's point, Save the Children is an excellent model for personal involvement. There is Maitreya's plan for creating the sort of solution to the deficit of medical care and education, and the other ills of poverty and deprivation, to be implemented when humanity is willing. Each nation inventories its needs and excess resources. That excess is put into an international pool, available to all nations having need of those resources. There would be your justice, freedom to develop within a nation's traditional culture, trust, and an end to the desire for war.see: share-international.org Read more

I totally agree with the aims and I like the concept of a small tax on tax havens - as a great way to start.The problems come when the distribution of such large amounts may take place; how do you avoid the syphoning off of large amounts by the usual culprits?The extension of the program may provide the answer; how we incentivize the children with short-term rewards (based on effort, rather than ability) and longer term value by way of higher education/ apprenticeships as a lead into good jobs; now we can hope for sufficient accountability to generate less stealing in the process.As another point raised below regarding US levels of aid, rather than applying a statutory fee of GNI, there may be a way to satisfy both views; targeted person to person support of children can be a great way to encourage and involve people. The more a program can be shown to have direct impact on the lives of individuals, the higher the support will be.So, an enthusiastic 'yes' from me; but let's go further to add certainty and generate real excitement for all involved! Read more

Your estimate of just $50B additional aid to give every child on Earth access to healthcare and high-school education would be incredible value for money. Indeed it would work out at just 0.06% of current Global GDP at $77T per annum.

To ignore this need is not only morally outrageous, but also economically stupid, so why doesn't it happen? The answer is that our national government policies are still based on "them and us" thinking, which is now holding back progress in the 21st century. To move forward we must stop seeing aid as a cost to G20 nations, and recognise that it actually presents one of the best investments we could make for long term Global growth. Africa is a prime example with huge opportunities for productivity growth, substantial natural resources, and a population that will more than double from 1 billion today to 2.5 billion by 2050. It's hard to think of a better way to promote future Global economic growth than to invest in poor regions around the World today.

I would love to see a respected group of Global economist present headline figures, not just for the costs of implementing the Global Goals, but more importantly the value they will add to future Global economic growth.

In the long term of course the answer to challenges of fair taxation and Global investment must be greater international cooperation, ideally through a new Global Economic Community. The obstacles are of course huge, but the prize of building a regulated single Global market with access to 9 billion consumers by 2050 would transform the future prospects for rich and poor alike.

Professor Sachs, the only potential problem I see with these highly laudable efforts is, that they could unintentionally contribute to further fuel ''youth bulges'' in developing countries, if they are not coupled with birth control commitments and policies: ''In some countries that received substantial PEPFAR funding, such as Uganda and Kenya, health surveys have found that fertility rates remained constant or even rose slightly over the past decade.'' - ''Bush birth control policies helped fuel Africa's baby boom'' http://www.mcclatchydc.com/news/nation-world/world/article24566695.html

''The Effects of ‘Youth Bulge’ on Civil Conflicts'' http://www.cfr.org/world/effects-youth-bulge-civil-conflicts/p13093 ''The Middle East, where 60 percent of the population is under twenty-five, is also susceptible to youth-bulge-related civil strife; as are countries with high HIV/AIDS rates. “The pandemic,” according to this January 2006 CFR Task Force report on Africa, “has reversed a generation of gains in human development, hitting young and middle-aged adults of all socioeconomic classes and leaving a dangerous youth bulge.”''

''Improve access to family planning measures. Improved reproductive health care and better access to family-planning measures, such as contraception programs, have proven effective in places like Iran, where births dropped from over six children per woman in 1979 to two per woman today. Better education programs for women can also help control the sizes of families and cause lower fertility rates.'' Read more

I don't know what your smoking but it sure must be powerful. The US won't even help their children or poor with health care or education. It is a honorable plan but you couldn't get the US congress to support it if they were being held at gunpoint. Read more

"Our world is immensely wealthy and could easily finance a healthy start in life for every child on the planet through global funds for health and education. A small shift of funds from wasteful US military spending, or a very small levy on tax havens’ deposits – or similar measures to make the super-rich pay their way – could quickly and dramatically improve poor children’s life chances and make the world vastly fairer, safer, and more productive. There is no excuse for delay." -- Jeffrey D. Sachs

"...each give at least 0.7% of GNI; the US can and should do so as well" - US citizens prefer to donate privately (and perhaps much more) usually through religious organizations. You wouldn't understand... Read more

Jeffrey, thanks for the article and indeed you raise some valid points. Surely Hobbes would be one way to reply here for the welfare of man is in a state of eternal conflict and there are only two sides to human nature...constructive and destructive.Not sure that the military industrial complex would agree with the rationale here, though what you propose makes sense.

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